HomeMy WebLinkAbout299144 ROCKY MOUNTAIN COATINGS - INSURANCE CERTIFICATE (3)DocuSign Envelope ID: AE52949E-4B2A-4A4E-8093-C78A5C781BF3
ACORO® AT OF LIABILITY INSURANCE mmlD014
�� FoT/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CON A
NAME:
PHONE JOHN C. BECKETT S ASSOCIATES, INC. (A/C, No, : (970) 484-2805 (/AVXC No: (S?0) 484-2a85
E-MAIL tim@beckettinsurance.com
220 Smith Street ADDRESS:
PRODUCER KKINTZLEY DENNIS DBA ROCKY MOUNTAIN COATING
CUSTOMER ID
Ft. Collins CO 80524— _ _ INSUR"CASUALTY
NAIC0
INSURED INSURER A :UNITED 0.2.1
DENNIS KINTZLEY DBA ROCKY MOUNTAIN COATING INSURER B
737 Knollwood Circle INSURER C
INSURER D
INSURER E
FORT COLLINS CO 80524— INSURER F
COVERAGES CFRTIFICATF NIIMRFR• ocvlclnu unaaeco.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUOR
WVD
POLICY NUMBER
POLICY EFF
(MMIDD/YYYY)
P DCY E P
MMIDDNYYY) EX
DN9Ta
A
GENERAL LIAMLRY
60430252
04/04/2013
04/04/2014
EACH OCCURRENCE
$ 1000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ® OCCUR
/ /
/ /
/ /
/ /
PREMISES EaEocculrence
$ 100000
MED EXP (Any one person)
$ 5000
PERSONAL 4, AOV INJURY
E 1000000
GENERAL AGGREGATE
$ 2000000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2000000
/ /
/ /
X POLICY PRO LOC
/ /
/ /
PREM
$
A
AUTOMOBILE
NABIL)TY
ANY AUTO
60430252
04/04/2013
4/04/2014
/ /
COMBINED SINGLE LIMIT
(Ea accident)
$ 1000000
BODILY INJURY(PWperacn)
ALL OWNED AUTOS
$
X
BODILY INJURY (Per accident)
SCHEDULED AUTOS
$
X
PROPERTY DAMAGE
(Par accident)
HIRED AUTOS
/ /
/ /
$
NON -OWNED AUTOS
/ /
/ /
$
X
UMBRELLA UAS
OCCUR
COVERAGE
/ /
/ /
EACH OCCURRENCE
E
AGGREGATE
E](CESS LAe
CLAIMS -MADE
/ /
/ /
$ -- _
DEDUCTIBLE
/ /
/ /
$
RETENTION $
/ /
/ /
s
WORKERS COMPENSATION
NO L.ovZRA"GE
V4C STATU- OTH-
AND EMPLOYERS' DABIUTVUII
ANY PROPRIETOR/PARTNERIEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED? ❑
(Mandatory In NH)
If yes, desaibe under
DESCRIPTION OF OPERATIONS below
NIA
/ /
/ /
/ /
/ /
S --
$
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYE
E.L. DISEASE -POLICY LIMIT
S
NO COVERAGE
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AtlAeh ACORD 101, Additional Remahs Schedok, R more span is required)
CITY OF FORT COLLINS IS AN ADDITIONAL INSURED PER WRITTEN CONTRACT ON THE GENERAL LIABILITY AND AUTO FOR THE ONGOING
OPERATIONS OF THE INSURED.
I:tK I INUA I t HULUtK CANCELLATION
( ) - (970) 498-5901
BRENDA DIVEN
CITY OF FORT COLLINS
OPERATIONS SERVICES
300 LAPORTE AVE, BLDG B
FORT COLLINS CO 80521-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
2R (2nnaroa)
n Aooa 9nnO Arnon rnonnonTnu Au
INS025120e9091 The ACORD name and logo are registered marks of ACORD